Characteristics and outcomes of heart failure-related hospitalization in adults with congenital heart disease

Abstract

Background: Heart failure (HF) is the main cause of death in adult congenital heart disease (ACHD).

Aims: We aimed to characterize HF-related hospitalization of patients with ACHD, and to determine HF risk factors and prognosis in this population.

Methods: We prospectively included 471 patients with ACHD admitted to our unit over 24 months. Clinical and biological data and HF management were recorded. Major cardiovascular events were recorded for ACHD with HF.

Results: HF was the main reason for hospitalization in 13% of cases (76/583 hospitalizations). Patients with HF were significantly older (median age 44±14 years vs. 37±15 years; P<0.01), with more complex congenital heart disease (P=0.04). In the multivariable analysis, pulmonary arterial hypertension (odds ratio [OR] 6.2, 95% confidence interval [CI] 3.5-10.7), history of HF (OR 9.8, 95% CI 5.7-16.8) and history of atrial arrhythmia (OR 3.6, 95% CI 2.2-5.9) were significant risk factors for HF-related admissions (P<0.001). The mean hospital stay of patients with HF was longer (12.2 vs. 6.9 days; P<0.01), and 25% of patients required intensive care. Overall, 11/55 (20%) patients with HF died, 10/55 (18%) were readmitted for HF, and 6/55 (11%) had heart transplantation during the median follow-up of 18 months (95% CI 14-20 months). The risk of cardiovascular events was 19-fold higher after HF-related hospitalization.

Conclusions: HF is emerging as a leading cause of morbidity and mortality in the ACHD population. Earlier diagnosis and more active management are required to improve outcomes of HF in ACHD.

Keywords: Arrhythmia; Arythmie; Cardiopathie congénitale; Congenital heart defect; Heart failure; Hypertension artérielle pulmonaire; Insuffisance cardiaque; Pulmonary arterial hypertension.